Provider Demographics
NPI:1942692520
Name:MARKHAM, KELSEY LYNN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:BREKKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:2500 E ENTERPRISE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8556
Mailing Address - Country:US
Mailing Address - Phone:920-416-8577
Mailing Address - Fax:
Practice Address - Street 1:2500 E ENTERPRISE AVE STE B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8556
Practice Address - Country:US
Practice Address - Phone:920-416-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6435125101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health